tbuckley/cabot-search huggingface dataset:
Abstract 9438: Serial Troponin T and Long-Term Risks of Myocardial Infarction and Revascularization in Patients With Suspected Acute Coronary Syndrome
Authors: Manan Pareek, Kristian Kragholm, Anna Meta D Kristensen, Tor Biering-Srensen, Christina Byrne, Emil L Fosbol, Lars Kober, Gunnar Gislason, Niels Thue Olsen, Deepak Bhatt, Christian Torp-Pedersen
Journal: Circulation (2022)

Introduction: Long-term prognostic implications of serial high-sensitivity troponin concentrations in patients with suspected myocardial infarction (MI) are unknown. Hypothesis: To determine short- and long-term risks of MI and revascularization (PCI or CABG) according to high-sensitivity troponin T (hsTnT) concentrations and their changes from baseline, in patients with suspected acute coronary syndrome. Methods: Retrospective cohort study based on Danish national registries. We identified all patients discharged from the hospital with either MI, unstable angina, suspected MI, or chest pain from January 2012 through December 2019 and merged them with records of two serial hsTnT measurements obtained 1-7 hours apart. Absolute risks of MI and revascularization were calculated through multivariable logistic regression with average treatment effect modeling (G-formula), with patients stratified in groups according to normal and elevated concentrations and relative changes of 20% and 50% from baseline. Results: Complete data were available in 28,902 individuals (median age [25 th -75 th percentile] 65.2 [53.4-75.4] years, 11,632 [40.2%] women). The standardized risk of MI was highest in individuals with two elevated hsTnT concentrations (0-30 days: 54.1%, 31-365 days: 9.7%) and lowest in those with two normal values (0-30 days: 2.5%, 31-365 days: 0.4%). In the latter group, the risk of MI did not appear to depend on the relative hsTnT change between samples while in persons with two elevated hsTnT concentrations, the risks at both 0-30 days and 31-365 days increased in a stepwise fashion with more pronounced hsTnT rises. Individuals with a &gt;20% to 50% fall also had a higher risk of MI than those with a less pronounced change while results were not significant for those with a &gt;50% fall. Finally, individuals who went from a normal to an elevated hsTnT level and had a concomitant &gt;50% rise had a significantly higher risk of MI at days 0-30 than those with a less pronounced rise. The standardized likelihood of undergoing coronary revascularization according to serial hsTnT concentrations followed the same pattern. Conclusions: Serial hsTnT measurements identify patients at long-term risk for both MI and revascularization.
Abstract 9602: Higher Anatomical Syntax Score is Associated With Lower Survival After CABG in the REGROUP Trial
Authors: Marco A Zenati, Andreas Habertheuer, Eileen Stock, Maria Arshanskiy, Brack Hattler, Ellen Dematt, Deepak Bhatt, Kousick Biswas
Journal: Circulation (2022)

Introduction: The SYNergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery (SYNTAX) score quantifies complexity of coronary artery disease (CAD) using angiographic data to objectively guide mode of revascularization. Recent studies evaluating complexity of CAD by the anatomical SYNTAX score (SS1) and impact on clinical outcomes following CABG have been inconclusive. Hypothesis: We sought to investigate the prognostic value of SS1 in predicting survival and incidence of major adverse cardiac events (MACE) following CABG in the REGROUP trial (ClinicalTrials.gov number NCT01850082.) Methods: This was a pre-planned sub-analysis of the REGROUP trial which randomized patients undergoing isolated CABG to endoscopic versus open vein harvest at 16 U. S. Veterans Affairs Medical Centers between 2014-2017; The median follow-up was 4.7 years (interquartile range 3.84-5.45). SS1 was extracted for all patients and stratified by terciles. Time-to-event survival analysis was performed for MACE defined as death from any cause, nonfatal myocardial infarction, or repeat revascularization over the study follow-up. Results: The mean SS1 for this cohort (N=1,145) was 28.5±11.5 (median 27). Mean age was 66.4±6.90 years, 50.2% were diabetics and 99.5% were males reflecting the Veterans population. According to SS1 terciles, low (&lt;23), intermediate (23-32) and high (&gt;32) SS1 groups comprised 383, 393 and 369 patients, respectively. Over study follow-up, SS1 terciles were associated with all-cause death (log-rank, p=0.012), which occurred in 8.6%, 14.2% and 15.2% of patients respectively (p=0.013). However, SS1 was not associated with higher rates of the composite MACE which occurred in 20.4%, 22.6% and 25.5% of patients (p=0.247). Conclusions: Over the REGROUP study follow-up, complexity of CAD evaluated by the SS1 is significantly associated with all-cause death, but not MACE.
Abstract 9401: Impact of Visceral Abdominal Tissue on Coronary Artery Disease as Defined by Quantitative Computed Tomographic Angiography
Authors: Daniel Karlsberg, Henry Steyer, Rebecca Fisher, Tami Crabtree, James K Min, James Earls, John A Rumberger
Journal: Circulation (2022)

Introduction: Obesity has long been associated with all-cause mortality and cardiovascular disease (CVD). Visceral abdominal tissue (VAT) has been proposed as an important CVD risk stratification metric and has been shown to correlate with the extent and severity of coronary artery plaque. This study aims to clarify the relationship between the presence and severity of VAT with the presence and severity of coronary artery plaque as defined by total plaque volume (TPV), calcified plaque (CP) volume, non-calcified plaque (NCP) volume, and high risk low-density non-calcified plaque (LD-NCP) using quantitative coronary computed tomography atherosclerosis imaging (AI-QCT). Methods: We reviewed 145 consecutive patients who had undergone CCTA and CT visceral fat analysis for health screening purposes. Atherosclerosis imaging - quantitative computed tomography (AI-QCT) was performed for TPV, percent atheroma volume (PAV), and the presence of stenosis. We segmented atherosclerosis by composition for CP, NCP and LD-NCP. Results: The mean age of the patients was 56.1 ± 8.5 years, 84.0% male. Overall, 3.5% had a history of diabetes, 19% hypertension, 38% dyslipidemia, 8% current smokers, and 34% had a family history of CAD. There was a stepwise progression of the median coronary plaque volume for each quartile of visceral fat including total plaque volume (Q1: 19.8, Q2: 48.1, Q3: 86.4, and Q4: 136.6 mm 3 (P=0.0098)), NCP (Q1: 15.7, Q2: 35.4, Q3: 86.4, and Q4: 136.6 mm 3 (P=0.0032)) and LD-NCP (Q1: 0.6, Q2: 0.81, Q3: 2.0, and Q4: 5.0 mm 3 (P&lt;0.0001)). Conclusion: Our findings represent the first demonstration of a stepwise progression with regards to visceral abdominal tissue and total plaque volume, non-calcified plaque volume, and, particularly of note, low density non-calcified plaque volume. A stepwise progression as demonstrated here may indicate the future usefulness of VAT in CVD risk stratification and its role in longitudinal preventive care.
Abstract 9842: Machine Learning-Based Prediction Model of COVID-19 Deterioration Using Wearable Core Temperature and Oxygen Saturation Sensor Data
Authors: Kazuya Miyagawa, Shinichiro Matsumoto, Masahiro Sasaki, Tatsuya Osaki, Masashi Furukubo, Hirofumi Tsuchimoto, Kenta Suzuki
Journal: Circulation (2022)

Background: Accurate prediction of COVID-19 deterioration could enable clinicians to make optimal decisions on medical interventions or hospitalization. A machine learning-based approach using vital data is recognized as a useful tool to predict the exacerbation of infectious disease. However, in COVID-19, effective prediction models are still emerging. Here we developed an algorithm to predict clinical deterioration in non-severe COVID-19 patients using machine learning techniques with continuous core temperature (CT), SpO 2 and pulse rate (PR) data obtained via wearable sensors. Methods: Fifty mild to moderate COVID-19 patients admitted to Nishi-Kobe Medical Center between December 2020 and August 2021 were enrolled. Disease severity was judged by WHO criteria. All patients wore a Moni-Patch ®️ , a wireless CT monitoring patch and a ring-type SpO 2 monitoring device. CT, SpO 2 and PR were continuously collected to a smartphone via Bluetooth ®️ . Data from 41 patients were of sufficient duration and quality to be analyzed and preprocessed to adjust sampling windows before fed into the framework. Additional features were derived by modifying the sensor data using patients’ characteristics. To develop classifiers to distinguish a disease deteriorating into severe one, XGBoost, a gradient-boosted tree algorithm, with 3-fold cross-validation was used. Based on the algorithm, deterioration into severe disease within 24 hour was inferred every single hour using 12-hour time frame data. The area under the curve (AUC) of receiver operating characteristics was analyzed based on the classifier’s prediction threshold. Results: After the enrollment, 13 out of 41 patients developed severe diseases. At the enrollment, baseline characteristics were comparable between mild to moderate and severe disease, except for body temperature that was significantly higher in severe disease. The algorithm developed using the sensor data was able to achieve an AUC of 0.92. Conclusions: Our algorithm could well distinguished COVID-19 deteriorating into severe disease. The results indicates that machine learning approach with continuous CT, SpO 2 and PR measurement using wearable sensors is beneficial to predict the exacerbation of COVID-19.
Abstract 9455: Sex Differences in Atrial Fibrillation Ablation Outcomes From the National Inpatient Sample Database 2016-2019
Authors: Biraj Shrestha, Julian Diaz Fraga, Bidhya Poudel, Anthony Donato
Journal: Circulation (2022)

Background: Research has shown mixed results when comparing in-hospital complications following atrial fibrillation ablation in women compared to men. Objectives: To better quantify sex differences and in-hospital outcomes in atrial fibrillation ablation procedures and identify factors associated with poorer outcomes. Methods: We queried the NIS database from 2016-2019 for hospitalizations with a primary diagnosis of atrial fibrillation ablation and excluded patients with any other arrhythmias, ICD/pacemaker placement. We assessed demographics, in-hospital mortality, and complications of women compared to men. Outcomes were adjusted for potential confounders using multivariable logistic regression analysis (Figure 1). Results: Admissions for atrial fibrillation were more common in females than males (849,050 versus 815,665; p&lt;0.001). However, females were less likely to receive ablation (1.65% versus 2.71%, OR: 0.60; 95% confidence interval: 0.57-0.64, p&lt;0.001) which persisted after adjusting for cardiomyopathy (adjusted OR: 0.61; 95% confidence interval: 0.58-0.65, p&lt;0.001). The primary outcome of in-hospital mortality was not statistically different in univariate analysis (0.39% vs. 0.36%, OR: 1.09, 95% CI: 0.44-2.72, p=0.84), finding that did not change when adjusted for comorbidities (adjusted OR: 0.94, 95% CI: 0.36-2.49) (Figure 1). The total unadjusted complication rate was higher for females than males (9.58% vs. 7.09%, p=0.001); however, it was not significant when adjusted for risks (adjusted OR: 1.23, 95% CI: 0.99-1.53, p=0.06) (Figure 1). Conclusion: Female sex is not associated with increased complications or death in a real-world study of catheter ablation when results are adjusted for risks. However, females admitted with atrial fibrillation receive ablation less often than males during hospital admission. More study is needed regarding to identify factors contribute to later referral for females for catheter ablation.
Abstract 9785: Association Between Initiation of Cardiac Rehabilitation After Hospitalization for Heart Failure and 1-Year Survival Among Medicare Beneficiaries
Authors: Kristen Lee, Peter Lindenauer, Aruna Priya, Penelope Pekow, Thomas D’Aunno, Kathy Mazor, Quinn R Pack, Sadiya S Khan, Tara Lagu
Journal: Circulation (2022)

Introduction: Cardiac rehabilitation (CR) reduces hospitalization risk in patients with reduced ejection fraction heart failure (HF). The CR HF mortality impact remains unclear. Methods: We identified Medicare beneficiaries diagnosed with HF between 2014-2017 who were hospitalized with HF diagnosis in 2017. Primary exposure was CR initiation within 180 days of HF hospitalization discharge in 2017; primary outcome was all-cause mortality within 1 year. In full cohort,Cox regression modeled time from discharge to death with time-varying exposure to CR, adjusting for unbalanced characteristics and propensity to initiate CR. We applied propensity score weighting and stratification methods. Using propensity score for CR receipt and survival to the day of CR initiation, we matched 1730 patients who started CR within 180 days to 1730 who did not and modeled survival from CR initiation. We examined association between CR initiation and mortality following CR in a landmark cohort and assessed dose-response relationship between session number and mortality. We conducted sub-group analyses limited to patients with systolic HF ICD code. Results: Of 116,302 HF patients (mean age 82 years, 54% women) admitted at 4,119 hospitals, only 1.5% initiated CR in 6 months. Overall 35% of patients died within 1 year; 10.7% among those who initiated CR within 180 days and 35.2% among those who did not. CR initiation within 180 days was associated with survival benefit in full and landmark cohorts as well as in the propensity-matched analysis hazard ratio [HR]: 0.39, 95% CI: 0.33-0.47; P &lt; 0.001 Among patients who initiated CR within 180 days and survived more than 180 days, completing 3 CR sessions was associated with lower death risk HR: 0.91 95% CI, 0.87- 0.95. In patients with systolic HF, HR: was 0.47, 95% CI 0.41-0.54; P &lt; 0.001. Conclusions: Few patients (1.5%) with HF enrolled in CR within 180 days after hospitalization. CR initiation was associated with reduced 1-year mortality risk.
Abstract 9800: Racial Differences in Donor-Derived and Mitochondrial Cell-Free Dna Could Explain Inferior Outcomes in Black Heart Transplant Patients, on Behalf of the Graft Investigators
Authors: Palak Shah, Sean Agbor-Enoh, Seiyon Lee, Temesgen Andargie, Shashank S Sinha, Hyesik Kong, Lawrence Henry, Woojin Park, Erick McNair, Inna Tchoukina, Keyur B Shah, Samer S Najjar, Steven Hsu, Maria Rodrigo, Moon K Jang, Charles Marboe, Gerald J Berry, Hannah A Valantine
Journal: Circulation (2022)

Introduction: Black heart transplant patients are at higher risk of acute rejection (AR) and death than White patients. Our group has shown that %donor-derived cell-free DNA (%ddcfDNA) is a sensitive and specific marker of AR in heart transplantation. Cell-free mitochondrial DNA (cfmtDNA) has been linked to allograft dysfunction and may mechanistically implicated in inferior outcomes for Black heart transplant recipients. Hypothesis: Higher levels of allograft injury when quantitated using %ddcfDNA and total cfmtDNA will be seen in Black heart transplant patients as compared to White patients. Methods: The Genomic Research Alliance for Transplantation (GRAfT) is a multicenter, prospective, longitudinal cohort study of heart transplant patients transplanted between 2015 and 2021. We included Black and White patients and shotgun sequencing was used to quantitate %ddcfDNA and polymerase chain reaction (PCR) to quantitate total cfmtDNA levels. AR was defined as grade ≥2R cellular rejection or pAMR ≥1 antibody-mediated rejection (AMR). Results: We included 151 patients (73 Blacks and 78 Whites), the median age was 56y (29% Female sex). Patients of both racial groups had comparable baseline characteristics. There were a ~1100 ddcfDNA and cfmtDNA measures included in the analysis. At 18-months, the incidence of AR was 2.8% in White patients and 9.2% in Black patients (p&lt;0.01). The diagnostic accuracy of %ddcfDNA to detect AR was comparable between Black and White patients (0.90 vs. 0.83, p=0.19). The %ddcfDNA and cfmtDNA was higher at serial time points after transplant in Black compared to White patients (Figure). CfmtDNA levels were also elevated with AMR which occurred almost exclusively in Black patients (No rejection: 146,345 copies/ul, AMR: 242,238 copies/ul; p=0.004). Conclusions: Elevated levels of %ddcfDNA and cfmtDNA after heart transplant may explain the higher incidence of AR, AMR, and inferior outcomes in Black heart transplant recipients.
Abstract 9772: Paroxysmal Atrial Fibrillation Among Pulmonary Embolism Patients; Insight From the 2019 National Inpatient Sample
Authors: Renuka Verma, Nomesh Kumar, Kamleshun Ramphul, Yogeshwaree Ramphul, Shaheen Sombans, Komal Kumari, Petras Lohana, Fnu Arti
Journal: Circulation (2022)

Introduction: Various factors can trigger events of Pulmonary Embolism(PE). Several studies have linked cardiac arrhythmias such as Paroxysmal Atrial Fibrillation (PAF) with a higher risk of multiple cardiovascular and pulmonary complications. As there is a paucity of data on the risk factors for an event of PAF among PE patients and the factors contributing to death, we conducted a retrospective analysis using the 2019 National Inpatient Sample(NIS). Methods: Our study focused on finding patients with a principal diagnosis of Pulmonary Embolism and a diagnosis of Paroxysmal Atrial Fibrillation. A multivariable regression model evaluated several risk factors for PAF incidence among PE patients and their possible mortality risks. Results: A total of 188,850 cases of PE were observed in our study, including 9,960 (5.3%) cases of PAF. Hyperlipidemia (aOR 1.348, 95% CI 1.290-1.409, p&lt;0.01), hypertension (aOR 1.988, 95% CI 1.887-2.095, p&lt;0.01), and old myocardial infarct (aOR 1.574, 95% CI 1.463-1.693, p&lt;0.01) predisposed to PAF among PE, while females (aOR: 0.873, 95% CI 0.837-0.910, p&lt;0.01), patients with obesity (aOR 0.858, 95% CI 0.818-0.900, p&lt;0.01), and those classified as racially Black (aOR 0.603, 95% CI 0.534-0.681, p&lt;0.01), and Hispanic (aOR 0.653, 95% CI 0.562-0.758, p&lt;0.01) (compared to group excluding Whites, Blacks and Hispanics) reduced their risk. An in-hospital mortality rate of 4.0% was also estimated as 395 patients with PAF died. PAF patients with PE had a higher chance of dying if they also had a diagnosis of diabetes (aOR 1.347, 95% CI 1.070-1.695, p=0.011), whereas those who were obese (aOR 0.421, 95% CI 0.311-0.570, p&lt;0.01), with hyperlipidemia (aOR 0.732, 95% CI 0.590-0.909, p&lt;0.01), and smokers (aOR 0.751, 95% CI 0.606-0.931, p&lt;0.01) expressed a lower risk of mortality. PAF patients with PE reported a higher overall risk of death during hospitalization (aOR 1.322, 95% CI 1.190-1.469, p&lt;0.01). Conclusions: Patients with a diagnosis of PAF while admitted with PE showed a higher risk of mortality. Several factors influenced the presence of PAF among PE patients. It is thus essential for physicians to monitor various cardiovascular complications and arrhythmias in patients admitted with PE.
Abstract 9316: Association of Racial and Educational Isolation on Outcomes in Infants With Congenital Heart Disease
Authors: Meredith Sooy-Mossey, Neeta Sethi, Hillary Mulder, Karen Chiswell, Timothy M Hoffman, Robert Hartman, Michael Walsh, Karl Welke, Joseph A Paolillo, Lauren Sarno, Charlie J Sang, Claire Osgood, Alfred DOttavio, Jennifer S Li, Marie Lynn Miranda
Journal: Circulation (2022)

Introduction: While race and socioeconomic status influence health outcomes in children with CHD, it is unknown whether neighborhood factors have additional effects . Hypothesis: Using previously developed measures of racial and educational isolation indices (RII, EII), we predict that measures of social isolation implemented at the census block level are associated with increased complications, resource utilization and death in infants with CHD. Methods We identified patients &lt; 1 year old undergoing CHD surgery in the CDC- NC CHD Surveillance database (2007-2012). We used negative binomial and logistic regression models to assess the case-mix adjusted associations between RII and EII and length of stay (LOS), mortality, post-operative complications, and resource utilization. RII used non-Hispanic White (NHW) race and EII used completed college as the reference groups (scale 0-1). Higher values of RII and EII indicate that NHBs are living in mostly NHB neighborhoods and non-college educated individuals are living in neighborhoods composed of mostly non-college educated individuals, respectively. Results: We included 1,217 infants who had CHD surgery at a mean age of 61 days (22% Black race, 14% Hispanic, and 34% Medicaid). Overall median RII (25 th -75 th ) score was 0.18 (0.09-0.32) and EII was 0.79 (0.67-0.86). After adjusting for age, sex, race, ethnicity, disease severity, preterm birth and LOS, there was an association between RII and outpatient encounter with decreased utilization as RII increases up to 0.3 (p&lt;0.001), then increased utilization as RII increases beyond 0.3 (p=0.017). NHB infants had increased LOS (p&lt;0.001), other complications (p=0.025), ≥1 ED visit (p=0.059), and death (p=0.02) compared to NHW infants when controlling for RII. There was an association with a significantly increased risk of ≥1 ED visit (p=0.001) at EII above 0.8. Conclusions: RII is associated with outpatient encounters in a non-linear fashion. Black race is associated with longer LOS, complications, ED visits and death after adjusting for patient factors including RII. These differences may be caused by differential access to resources or community support. Investigation into effective interventions to improve health equity is essential.